Gn累积使用时间和使用量对后续冻融周期临床结局的影响  

The Impact of Duration and Accumulative Dosage of Gonadotropin on the Pregnancy Outcomes after Subsequent Freeze-thawed Embryo Transfer Cycles

作　　者：刘闯 马媛 海溧 李博 谢荣霞 吕佳星 王晓红 LIU Chuang;MA Yuan;HAl Li(Rreproductive Medicine Center,Department of Obstetrics and Gynecology,The Dangdu Hospital of Air Force Military Medical University,Xi'an Shanxi 710032,China)

机构地区：[1]空军军医大学唐都医院妇产科生殖医学中心,陕西西安710032

出　　处：《实用妇产科杂志》2019年第1期49-53,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨辅助生殖技术促排卵过程中累积促性腺激素(Gonadotropin,Gn)用量和促排时间对后续冻融胚胎移植(FET)周期妊娠结局的影响。方法:回顾性收集2016年10月1日至2017年11月31日在空军军医大学唐都医院妇产科生殖医学中心行FET周期资料,共计1923个FET周期纳入研究。根据促排卵过程中Gn促排时间不同,将研究对象分为3组:(Ⅰ组:Gn促排时间<10天,223个周期;Ⅱ组:10天≤Gn促排时间<15天,1468个周期;Ⅲ组:Gn促排时间≥15天,232个周期)。采用单因素和多因素Logistic分析方法探讨Gn累积用量对着床率、临床妊娠率、早期流产率、异位妊娠率和继续妊娠率的影响。结果:单因素和多因素分析结果显示,着床率、临床妊娠率、早期流产率、异位妊娠率以及继续妊娠率不同Gn促排时间组比较,差异无统计学意义(P>0. 05)。进一步分析各组Gn用量和促排时间对结局交互作用影响,结果显示Gn促排时间≥15天,且Gn累积用量≥40支时,FET周期的胚胎着床率(β-0. 12,95%CI-0. 24,0. 001,P=0. 04)和临床妊娠率(OR 0. 41,95%CI 0. 21,0. 80,P=0. 01)显著下降。结论:促排卵过程中Gn使用具有累积效应,当Gn使用时长小于15天时,Gn使用并不影响后续冻融胚胎妊娠结局,而当Gn使用时长超过15天,Gn累积用量超过40支(≥3000 U)可能降低后续FET周期的着床率和临床妊娠率。Objective: To study the impact of duration and accumulative dosage of gonadotropin on the pregnancy outcomes after subsequent freeze-thawed embryo transfer cycles( FET). Methods: The data was retrospectively collected from the database of Reproductive Medicine Center of the Tangdu Hospital,the Air Force Military Medical University from October 1st,2016 to November 31 st,2017.A total of 1923 FET cases were analyzed for inclusion.According to the length of stimulation period of Gn,the cohort was categorized into three groups( group Ⅰ: Day<10,n=223;group Ⅱ: 10≤Day<15,n=1468;group Ⅲ: Day≥15,n=232).Univariate and multivariate logistic regression models were used to assess the association of accumulated period of COH on implantation rate,clinical pregnancy rate,early abortion rate,ectopic pregnancy rate and ongoing pregnancy rate in FET cycle.Results: Univariate and multivariate logistic regression models showed that,between the three groups,there was no significant differences( P > 0. 05) in the implantation rate,clinical pregnancy rate,abortion rate,ectopic pregnancy rate and ongoing pregnancy rate.After analysis of interact effect of accumulative dosage of Gn in each groups,it showed that implantation rate( β-0. 12,95%CI-0. 24,0. 001,P = 0. 04) and clinical pregnancy rate( OR 0. 41,95%CI 0. 21,0. 80,P=0. 01) decreased in group C when dosage of Gn was more than 3000 U,and the difference was statistically significant( P <0. 05). Conclusions: During COH cycle,the implantation rate and clinical pregnancy rate in the subsequent FET cycles may decreased when the accumulative time more than 15 days and the accumulative dosage of Gn more than 3000 U.

关 键 词：促性腺激素 冻融胚胎移植周期 临床妊娠率 着床率 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]